[Clinical evaluation of the vulva reconstruction with myocutaneous flap transposition after radical vulvectomy].

Thirty-three cases with carcinoma of vulva were treated in the division of gynecologic oncology from July, 1989 to April, 1994. Out of 33 cases, 18 with stage II or III underwent radical vulvectomy, pelvic and inguinal lymphadenectomy. These were divided into 3 groups based on the different methods of vulval reconstruction: (1) simple suture group (6 cases); (2) cutaneous flap group (4 cases); (3) myocutaneous flap transposition group (8 cases). The large defect area left by radical vulvectomy and inguinal lymphadenectomy was reconstructed by myocutaneous flap, tensor fascia latae flap, in 6 cases and musculus gracilis myocutaneous flap in 2 cases. All the cases in group 1, 2 suffered from breakdown of wounds, infection or necrosis, resulting in long term hospitalization (mean duration 36.3 days), delayed scar pains, and problems in walking or sexual activity. Primary wound-healing was observed in the 6 cases of group 3, wound infection occurred in one case with diabetes and one case of relapse cancer after radiation therapy. The mean duration of hospitalization in group 3 was 20 days, and neither scar pains nor problems in sexual activity was found after a follow up of 6 months to 4 years. One case in this group died of brain metastases of cancer of vulva. The indications and advantages of myocutaneous flap transposition are discussed. It is suggested that myocutaneous flap transposition surgery is clinically one of the best and safest methods for reconstruction of the vulva and it can improve the quality of life.